Intended for healthcare professionals


Improving treatment of asthma attacks in children

BMJ 2017; 359 doi: (Published 29 December 2017) Cite this as: BMJ 2017;359:j5763
  1. Andrew Bush, professor of paediatric respirology1,
  2. Chris Griffiths, professor of primary care2
  1. 1National Heart and Lung Institute, Royal Brompton Harefield NHS Foundation Trust, London, UK
  2. 2Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, UK
  1. Correspondence to: A Bush a.bush{at}

UK children and young people have the highest death rate from asthma in Europe

An acute asthma attack is frightening and serious. The common term for these attacks—“exacerbation,” defined as the worsening of a disease or an increase in its symptoms—undervalues an event that is predictive of further acute deterioration and death, with serious long term consequences, including restriction of lung growth into adulthood.1 Asthma still kills people of all ages2; there are preventable factors in the majority of deaths, and the UK has the highest death rate from asthma in children and young people in Europe.3 We must do better.

The underlying pathophysiology of an asthma attack is severe airway obstruction as a result of smooth muscle constriction and plugging of the airway by inflammatory cells and mucus. This leads to increased work of breathing and also hypoxaemia because of ventilation: perfusion (V:Q) mismatch. The signs of airway narrowing (wheeze) and increased work of breathing (subcostal recession, use …

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